Career Profile: working as a locum GP

Dr Michael Uprichard, former Chairman of NASGP (National Association of Sessional GPs), explores the practicalities - and the pros and cons - of working as a locum GP

Q: In your experience what are the main advantages of being a locum GP?

A: Working as a locum GP gives me the freedom to choose, generally, where I want to work and for whom, market conditions permitting.

Also, given the bureaucracy and scrutiny that affect, or should that be afflict, static GP surgeries, being a locum GP can be a liberating experience - allowing you to practice medicine without, in large part, much of the administrative angst.

Q: What are the financial implications?

A: Generally, having chosen to work independently, and often as a peripatetic health professional, this may or may not involve working less hours and consequently receiving a lower remuneration than colleagues who are partners. However, this can be augmented, for those who are so inclined, by earning income through other opportunities such as Out of Hours work or working for a PCT.

Q: Is there anything about the way locums work that might be seen as a disadvantage?

A: Having to work with different medical computer packages, sometimes up to three different ones in a week, can be stressful unless you have taken the time to familiarise yourself well beforehand.

If you have chosen to do locum General Practice as a career choice then the lack of continuity and follow up can be vocationally barren in the long run and could contribute to disillusionment and burn-out.

Travelling long distances can be tiring too, especially at the end of a long day. It is not uncommon for locum GPs, especially if they are working through agencies, to travel up to an hour or more each way. With the reduction in the number of locum GP sessions available, doctors have to travel further afield. This can become a disadvantage in comparison to doctors who work in a fixed practice as partners, where travel might be limited to half an hour or less.

Q: Are there any ways of reducing the possible disadvantages?

A: The NASGP website has links to several of the principal medical computer applications where typical pages of the particular application can be found and read up on.

To mitigate the problem of lack of continuity, performing long term locums of several months at a time would be an option and should be seriously considered.

The disadvantage of travelling long distances may just have to be accepted unless you are fortunate enough to acquire a post at a nearby practice often self researched.

Q: If I want to become a locum GP, what can I do to find work?

A: You could send out letters to local practices together with your CV; introduce yourself to the local medical postgraduate centre; and/ or attend local Sessional GP subgroups to familiarise yourself with opportunities and use the opportunity to network.

Q: What about agencies?

A: Agencies can be helpful in finding you work, therefore saving you the time and trouble of researching this for yourself. This might be particularly useful when you are starting out as a locum. They can also provide advice and reduce a little of the paperwork. It is important though to be aware of contractual obligations and whether or not this will prevent you contacting practices directly in the future should you so wish. Also, if you are employed to work for an agency under current NHS Pensions regulations your salary would not be superannuable under the NHS Pension Scheme.

Q: Who do I need to be registered with or inform?

A: You need to be on the Performers List register through your local Primary Care Organisation if you want to work as a GP contractor to the NHS. Currently, however, if you are on a Performers List in one country in the UK this does not confer the right to practice as a GP locum in another country in the UK unless you are also represented in that country as well. There are prerequisites to registering on the Performers Lists. These include criteria such as being currently accredited as a GP, declaring that you are fully registered with the GMC, evidence of your qualifications, details of previous medical work performed etc. See also: www.dh.gov.uk/assetRoot/04/07/68/12/04076812.pdf

It is also important for you to have medical litigation insurance, and, to register with Revenue and Customs (HMRC), as a self employed person where this is appropriate.

Q: How good a financial manager do you need to be as a locum?

A: It is important for you to keep on top of your paperwork and record all jobs done as well as basic recording requirements for Income Tax returns and routine administrative procedures, banking your earnings etc. Some of this requires daily attention and some monthly. Most locums who are self employed do most of this themselves or may employ a member of their family to keep up to date with these records. It is useful and advisable to utilise the services of an accountant for advice and, if you do not feel competent, for completion of your tax returns for the tax year. There is, however, generic software which you can use for tax completion and indeed completion online with Inland Revenue. It really depends on how competent you feel in this regard. Ultimate responsibility, however, rests with you as the owner.

Q: How can I keep up to date professionally?

A: There are a number of ways you can do this and guidance through your local Post Graduate Tutor can be helpful. Online learning and interactive tutorials are useful for the busy GP; attendance at Post Graduate meetings organised in your area; attendance at Sessional GP Group academic meetings; involvement with Significant Event Meetings at the practices at which you work; journal reading, to mention just some.

Q: What equipment would you suggest a locum takes with them?

A: I find that I like to carry as a basic set of equipment, stethoscope, portable BP monitor, digital thermometer, tape measure, a directory of useful contact telephone numbers for the surgery/ area in which I am working. If I were to have space I would entertain a headlamp and loupe as practice examination lamps are often hopeless.

You may wish to carry an emergency bag though I have found that this has uncommonly if rarely been required provided you can be supplied with medications/ equipment for individual circumstances in which you may have to visit away from the surgery, eg on a home visit. If you are working for an Out of Hours Provider they will usually provide an emergency drug bag if you are the visiting doctor. The problem is usually the storage of drugs as well as medications rapidly going out of date.

Q: What would your top three tips be for someone starting out as a locum GP?

A: Ask yourself how long you will consider being a locum: is this simply an interim arrangement allowing you to research different practices you might like to join on a permanent basis or are you considering making a career of this to facilitate an overall portfolio career? This will inform your short, medium and long term planning.

Allow for a quiet period when first starting out as it will inevitably take time for you to get yourself known as well as getting yourself and your systems organised without too much other pressure. Perhaps diarise how many sessions per week you will be prepared to work in the initial period. This preparatory period should not be longer than two to three months. If you are very well organised you may not need as long as this.

Make sure you have contacted surgeries in the area you expect to work before you contact the agencies. This may have contractual advantages and on this note make sure you understand the contract/ agreement you are entering into with agencies. Remember, they are working on your behalf not the other way round.

Q: Where can I find out more?

A: Visit the National Association of General Practitioners (NASGP) website www.nasgp.org.uk where there are links to various useful sites - better still become a member. Other agencies include the BMA and the Royal College of General Practitioners. Don't forget your local Sessional GP Groups.

Dr Michael Uprichard is the former Chairman of the National Association of Sessional GPs (NASGP)